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90 Cards in this Set
- Front
- Back
Axis I
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-Major Depression
-Bipolar Disorder |
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Axis II
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-Personality Disorders and Mental Retardation
-Antisocial Personality Disorder -Borederline Personality Disorder -Autism -Language Skills Disorder |
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Axis III
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-General Medical Conditions
-Affects mental state or things that need to be known (hip precautions for someone who just had hip surgery) -Diabetes |
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Axis IV
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-Psychosocial and Environmental Problems
-Problems with primary support groups -Educational problems -Occupational problems |
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Axis V
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-Global Assessment of Functioning Scale (GAF)
-Looks at psychological, social, and occupational functioning -Score is give for current functioning -Score is between 1-100 where 100 is the healthiest score |
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LPS
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-Lanterman, Petris, Short Act
*legislated legal protections for the patients *LPS conservatorship *created the psych health facilities *least restrictive setting: people should be housed in place with the least amount of restrictions and structure to keep them safe |
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Short-Doyle Act
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-To provide funding for the provisions in the LPS act to be carried out
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5150
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-Legal hold for 3 days (72 hours)
-Period of evaluation -Date and time must be on admittance paper work (nurse's responsibility to verify) -No legal recourse -Created by the LPS act -Must meet one of the following: *Daner to self *Danger to others *Gravely disabled (unable to provide or utilize clothing, shelter, or food) |
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5250
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-Hold up to 14 days in length
-Probable cause hearing: *Pt and Pt Advocate *Represenative for facility *Judge -Writ of Habeus Corpus: *if patient loses probable cause hearing they can request a writ hearing *In courtroom with judge and attorney |
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5270.15
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-Legal hold up to 30 days
-Probable cause hearing -Writ hearing if requested by pt |
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Conservatorship
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-Temporary Conservatorship (T con)
*30 days to allow the facility to prepare a case for conservatorship *Is decided if pt is still not able to care for self after 47 days at facility -Conservatorship: 1 year in length then must be renewed *pt can request a jury hearing once during conservatorship *Pt does not have: right to sign legal documents, decide where to live, contol over money |
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Legal Holds
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-4011.6: come from jail for evaluation
-1368: evaluated to see if fit competent to stand trial (at least two months) -1370: incompetent to stand trial by reason of mental illness -To be competent to stand trial pt must: *Understand charges being brought against them and *Be able to work with an attorney |
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Pt Rights and hearings
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-Pt has right to refuse medication unless:
*they are on a conservatorship *a harm to themselves or others right at that moment -Riese hearing: for pts who refuse to take their medications -Copacity Hearing: ability of pt to give conformed consent |
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Affective/Mood Disorders
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-Affect: facial expression
-Major Depression -Bipolar Disorder |
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Affective/Mood Disorders
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-Affect: facial expression
-Major Depression -Bipolar Disorder |
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Major Depression
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-Symptoms must be present at least 2 weeks
-Must be change in usual functioning -Person must be different than what they usually are like -Must have depressed mood and or loss of interest or plessure and at least 4 of the following symptoms: *feelings of worthlessness *excessive or inappropriate guilt *indecisiveness (trouble making simple decisions) *recurrent thoughts of death *weight loss of weight gain *insomnia or hypersomnia *fatigue or loss of energy *psychomotor agitation or retardation (vegatative) |
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Major Depression with psychotic Features
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-In addition to previous criteria there must also be:
*Hallucinations: any 5 senses (sensory perceptions occurs in absence of external stimuli *Delusions: a personal belief that is most certainly not true (can't change this believe with facts or medication) -Illusion: misinterpretation of real stimuli -Most common in elderly |
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Recognizing Escalation
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-Profanity
-Display increasing signs of anger/irritation -Loss of self control -Notify staff immediately -Early intervention is important for safety |
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Setting Limits
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-Goal: help patient establish behaviors that fit into society and encourage socialization
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Safe Student Behavior
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-Arms length away from pt
-Larger personal space -Don't touch pt without permission -Don't turn your back on pt -Keep pt in line of sight -Don't be alone in room with pt -Don't be in room with door shut -Watch nonverbal behavior (crossed arms) -Same level as pt |
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Assesssing a Person's Mental Health
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-Orientation to person, place, time
-Apperance: hygiene/dress -Eye contact -Affect: facial expression -Behavior -Activity: groups, pacing -Thought content: what is being thought -Thought Flow or process -Speech |
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Major Depression
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-Orientation: should be x3
-Eye contact: lessoned, fleeting -Affect: flat, unchanging, sad, crying -Appearance: could be anything -Behavior: aggitated, anxious, lying in bed -Activity: probably wanting to disengage/withdrawn -Thought flow: thinking organized or tangential -Speech: could be queit |
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Depressive symptoms in the Elderly
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-Loss of interest in usual activities
-Fewer complaints of guilt and lowered self-esteem -c/o poor memory and poor concentration -multiple symptoms -early morning awakening |
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Depressive Signs in Teens
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-Change in function at school
-loneliness -Low self-concept -Drug abuse -often irritable rather than sad |
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Postpartum
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-Cyring a lot
-Thoughts of harming the baby -Thoughts of harming self -Lack of interest in the baby -Symptoms go on and on -Lack of sleep doesn't help -These are normal in a new mom but the sx or brief |
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Neurotransmitters
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-Norepinephrine
-Serotonin *more = better mood -Dopamine -GABA: gamma amino butyric acid Depression is caused by a neurotransmitter dysregulation *decreased amounts of serotonin and/or norepinephrine will cause mood to decrease |
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Major Depression Recurrence Rate
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-50-60% after first episode
-70% after second episode -90% after third episode |
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Major Depression Treatment
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-Antidepressant Medication:
*TCAs: tricyclic antidepressants *SSRIs: selective serotonin reuptake inhibitors *MAOIs: monoamine oxidase inhibitors -Counseling -PEP and other support groups |
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Tricyclic Antidepressants (TCAs)
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-Oldest anti-dep. drugs
-Cheapest -Onset of action: 7-10 days -Full affect 4 weeks -Action: inhibits reuptake of norepinephrine or serotonin at the presynaptic neuron -Suicide risk increases during the first 2-3 weeks of treatment due to more energy and increase in restlessness, aggitation, and anxiousness -Phone contact important |
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TCA Side Effects
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-Anticholinergic
-Cardiovascular: tachycardia, orthostatic BP changes, (20-30 SBP), arrhythmias, T-wave abnormalities -Psych: anxiety, confusion, psychotic behavior (must have an adequate baseline) -Neuro: tremors, drowsiness, hung-over feeling -Endocrine/Metabolic: increase or decrease libido, impotence, weight gain -Easily fatal if mixed with ETOH -Other uses: *enuresis control *chronic pain |
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Anticholenergic Side Effects
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-Dry mouth
-Aggitated and anxious -Constipation -Urinary Retention -Blurred Vision -Can't see, can't pee, can't spit, can't shit |
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Heterocyclics
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-4 weeks for full affect
-Serotonin and norepinephrine reuptake inhibitors -buproprione (Wellbutrin) -mirtazepine (Remeron): mostly older people d/t wght gain d/t increased appetite -trazadone (Desyrel): makes people sleepy |
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Heterocyclics Side Effects
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-Dry mouth
-Sedation -Tachycardia -Headache -N/V -Priapism: continually erect penis seen mainly in Desyrel -Seizures: Wellbutrin d/t decreased seizure threshold -Hypotension |
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Selective Serotonin Reuptake Inhibitors
(SSRIs) |
-fluoxetine (Prozac)
-paroxetine hydrochloride (Paxil) -sertaline (Zoloft) -citalopram (Celexa) -escitalopram (Lexapro) -fluvoxamine (Luvox) -Onset of action: 7-10 days -Full effect 4 weeks |
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SSRIs Side Effects
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-Anxiety
-Insomnia or somnolence (want to sleep) -Impotence -Inorgasmia -Nausea |
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Serotonin Syndrome
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-Occurs when SSRIs are taken at the same time or within several wks as other drugs that increase Serotonin such as MAOIs
-Diarrhea, cramping -Tachycardia, labile bp, hyperflexia -Fever, Diaphoresis (profuse sweating), shivering -Staggering gait -Mania -Restlessness, disorientation, confusion -Death |
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Nonselective Reuptake Inhibitors (NSRI)
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-venlafaxine (Effexor)
-nefazodone (Serzone) -duloxetine (Cymbalta) -Full effect: 4 wks -Action: *inhibits neuronal reuptake of Serotonin and Norepinephrine *weak inhibitor of dopamine |
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NSRIs Side Effects
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-Headache
-Dry Mouth -Nausea -Somnolence -Dizziness |
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Monoamin Oxidase Inhibitors (MAOIs)
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-Last Resort
-Mechanism: Increases morepinephrine stored in adrenergic neurons -Examples: Nardil (most common) & Parnate -Full effect: 4 wks -Special Diet: No Tyramin (amino acid) *Aged, smoked, fermented products *Bananas, avacado, chicken liver *ETOH *only small amounts of caffeine ok |
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MAOIs Side Effets
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-Hepatic Necrosis: can be fatal
-Eating Tyramine foods: can lead to hypertensive crisis, intracranial bleed, and death -Interaction with other meds: *Sympathomimetics can cuase release of stored norepinephrine, hypertensive crisis *asthma meds: albuteral, Terbutaline *epinephrine *Isuprel *Cold and hay fever meds *Weight reducing meds -Refer pt to pharmacy when doing teaching -Should not be prescribed to someone who is unable to have strict compliance |
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Sympathomimetics
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-Drugs partially or completely mimic the actions of epinephrine or norepinephrine
-Epi and Norepi stimulate the SNS (fight or flight) -SNS regulates heart and peripheral vasculature, esp. in response to stress |
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Sympathomimetics Side Effects
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-Tachycardia/palpatations
-Sweating -Tremors -Agitation -Insomnia -Aggravation of psychosis (out of touch with reality) |
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Bipolar Disorder: Mania
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Distinct mood of abnormally and persistently elevated exansive, or irritable mood lasting at least a week
*Inflated self-esteem or grandiosity *Decreased need for sleep *Pressured speech/more talkative than usual *Flight of ideas or feeling thoughts are racing |
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Mood Stabilizing Drugs
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-Antimanics: lithium (Lithobid)
-Only drug classified antimanic *Action: enhances re-uptake of norepi and serotonin, decreases levels in the body *Takes 1-3 weeks to work *Therapeutic Blood Levels: 0.6-1.5 *Titrate 4-5 days after treatment is started |
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Antimanics: lithium
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-Side Effects:
*Drowsiness, dizziness, H/A *Dry mouth, thirst *GI upset (take with food) *Fine hand tremors *Hypotension, arrhythmias, pulse irrug. *Polyuria, dehydration *Weight gain -Over dose *vomiting and diarrhea leads to ataxia and slurred speech then coma, seizures, electrolyte imbalance the cardiac arrest (li > 2.0) -Interactions: *Diuretics, NSAIDs and ASA with lithium lead to decrease in renal clearance of Li and could cause death -Adverse Reactions: *Edema *Renal Failure |
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Mood Stabilizing Drugs: Anticonvulsants
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-carbamazepine (Tegretol)
-divalproex sodium (Depakote) *used for bipolar disorder: rage reactions, resistant schizophrenia *SE: drowsiness, dizziness, N/V *carbamazepine: monitor CBC, platelets, chem panel and lytes *divalproex sodium: thrombocytopenia -Monitor blood levels and keep in therapeutic range |
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Illusion
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Misperceptions and misinterpretations of externally real stimuli
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Delusion
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An important personal belief that is almost certainly not true
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Hallucination
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A sensory perception that occurs in the absence of external stimuli
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Schizophrenia
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-Axix I
-2 or more of the following: *delusions *hallucinations *grossly disorganized or catotonic *netative symptoms: affective flattening, alogia, avolition -And: *Social/occupational dysfunction: work, interpersonal relations, self-care *Continuou sypmtoms for 6 months: d/t schizophrenia looking like other illnesses or drug use |
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Schizophrenia: positive symptoms
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Delusions and Hallucinations
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Schizophrenia: Negative Symptoms
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-Something that missing or present in normal people
*flat affect *alogia: without speech *avolition: without motivation |
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Schizophrenia Subtypes
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-Paranoid: Prominent delusions and/or hallucinations
*Later onset: 30-35 years of age -Disorganized: speech, behavior, flat or inappropriate affect *Early onset: 16-25 years of age *Need step-by-step instructions -Catontonic: marked by psychomotor disturbance, immobility (wax flexibility), like a wood structure *echolalia: repeating phrases/words *echopraxia: repeating gestures *short term tx: ativan -Undifferentiated/Mixed: symptoms not clearly falling into any of the other subtypes |
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Types of Delusions
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-Grandiose: queen of England
-Jealous: SO having an affair -Persecutory: FBI out to get me -Somatic: something to do with body -Bizarre: *thought broadcasting: sending ideas out of head into another person's *thought insertion: someone putting thoughts into head *being controlled by a dead person |
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Nursing Interventions for Delusions
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-Ignore Delusions:
-Set Limits: -Give PRN medications: -Present Reality: done only when related to delusions d/t anethesia and/or pain medication -Delusions are not effectively treated with medications -Try to address the feelings around/behind the delusion |
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Nursing Interventions for Agitation
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-Regonize escalation
-Decrease environmental stimuli -Talk down patient -Set limits -Give PRN meds |
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Nursing Interventions for Hallucinations
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-Decrease environmental stimuli
-Give PRN meds (work well) -Present reality: r/t reversible cond. -Attempt to identify percipitating factors |
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Nursing Interventions for Suspiciousness
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-Be sincere and honest
-Avoid making promises that can't be kept -Face the patient when talking -Avoid whispering -Explain tests and procedures -Allow the patient to prepare own food if refuses to eat because he feels he is being poisoned |
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Antipsychotics/Neuroleptics
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-Used for:
*Schizophrenia *Schizoaffective Disorder: disorder with mixed affective and psychotic sx *Various dementias *Any psychotic sx -Action: decreases delusions, hallucinations and allows thinking more clearly |
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Deconate
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-Injection that lasts 2-4 weeks
-Available only in Prolixin, Haldol, and Risperdal Consta -Expensive: $100 per dose -Give deep IM -For those that are noncompliant, have difficulty swallowing, or have memory issues |
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Old/Typical Antipsychotics/Neuroleptics
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-Phenothiazines
*generics end in azine *chlorpromazine *fluphenazine -Non-Phenothiazine *haloperidol (Haldol) *thiothixene (Navane) *loxapine (Loxitane) |
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Old/Tyoical Antipsychotic/Neuroleptics Side Effects
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-EPS
-Anticholinergic -Other |
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Extra Pyramidal Symptoms (EPS)
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-Acute Dystonic Reaction
*spasms or muscle stiffness *black man from video -Parkinsonian Syndrome *slowness in movements, tremors, change in gait or posture -Akathesia: *severe form of restlessness (compulsion to move), mostly seen in the thighs and abdomen -Tardive Dyskinesia *set of late onset irreversible movement disorders *constant random movement *dystonia, tics, and myaclonus |
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Acute Dystonic Reaction
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-Bizarre and severe muscle contractions
-Torticollis: wry neck (pulls head off to side, contracting neck muscles) -Opisthotonos: arched backwards due to contraction of spinal muscles -Occulogyric crisis: contraction of eye muscles causes eyes to roll in different directions -Jaw stiffness -Drooling |
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Pseudoparkinsonism
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-Drooling
-Resting Tremors -Rigid posture with slow voluntary movements -Shuffling gait |
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Akathisia
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-Client feels motor restlessness
-Feels urge to pace -Shifts weight from one foot to the other -Feels can't sit or stand still |
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Tardive Dyskinesia
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-Irreversible
-Involuntary movements of face, jaw, tongue, lips -Lip smacking -Protrusion of tongue -Jerky or writhing movements of extremities |
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Anticholinergic Side Effects
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-Dry mouth
-Blurred vision -Constipation -Urinary retention/hesitance |
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Anticholinergic/Antiparkinsonian Meds
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-benztropine (Cogentin)
-trihexyphenidyl (Artane) -diphenhydramine (benadryl) |
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Neuroleptic Malignant Syndrom: Sx
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-Comes on rapidly
-Mute: disoriented and confused -Immobile/rigid -Profound diaphoresis -Febrile Temp 107 -Tachycardia -Hypertension -Increased CPK: creatine phosphate kinase (muscle damage) -Increased LDH -Increasd HCT d/t dehydration -Leukocytosis -Increased BUN and creatine Dehydration -Tx: stop medication (neuroleptics), give fluids, lower temp. (hypothermia blanket and antipyretics) |
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Atypical Antipsychotics
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-clozapine (Clozaril)
-risperidone (Risperdal): no decrease in WBCs same SE as clozapine -olanzapine (Zyprexa): widely used, high risk of causing diabetes II & wght -quetiapine (Seraquel): widely used -ziprasidone (Geodon) -Aripiprazole (Abilify) -Action: binds to dopamine and serotonin receptors to block dop & ser. -Dopamine blocks: decreases + sx of schizophrenia (hall and delusions) -Serotonin blocks: decreases - sx of schizophrenia (flat affect, social withdrawl) -SE: hyperglycemia, wght gain, may cause diabetes, black box warning |
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Clozapine
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-Clozaril
-Requires a WBC check every week while on drug -onset 2-4 weeks |
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Antisocial Personality Disorder
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-AKA sociopath, psychopath
-Early onset: usually before age 15 -Does not respond to medication -Rights of others are ignored -More common in males -Relatively anxiety-free -Requires immediate gratification -Interventions: *set limits *do not bargain, argue, rationalize *do not seek approval *do not be influenced by flattery or verbal attacks *use contracts and peer pressure *teach delayed gratification |
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Borderline Personality Disorder
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-Fear of real or imagined abandonment
-Intense, unstable relationships -Identity Diffusion: negative stage of Eriksons (get stuck here) -Gender Identity confusion -Impulsive -Splitting: *seeing the world as all good or all bad *split the staff against each other -Mashochistic: self inflicted pain -Affective instability: labile mood -Feelings of empiness -Intense anger or projection of anger -Causes: *trouble seperating from parents *traumatic experience around 18mos old *75% are abused as children |
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Boderline Personality Disorder Interventions
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-Frequent staff discussions
-Treat consistently: have a single person be in charge -Encourage client to set daily goals and to talk about body image (long term setting) -Teach constructive coping methods *journal writing -Maintain cosistent, firm limits -Matter of fact, but caring approach |
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Somatoform Disorders:
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-Body like Symptoms: physical but no physiological disorder is present
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Conversion Disorder
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-A conversion of anxiety into a somatic complaint.
-It involves a loss of or change in bodily functioning resulting from a psychologic conflict -Convert anxiet into a physical sx -Saw something awful - became blind |
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Somatization Disorder
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-Seek medical attention for recurrent and multiple somatic complaints of several years duration that are without a physical cause
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Hypochondriasis
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-Preoccupied with the fear or belief that they have a serious disease
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Anxiety Disorders
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-Acute Stress Disorder:first 30 days then changes to PTSD
-Posttraumatic Stress Disorder: intrusive recollections -Generalized Anxiety Disorder -Social Phobia (social anxiety disorder) -Specific Phobia -Obsessive-Compulsive Disorder -Substance-Induced Anxiety Disorder -Agoraphobia -Panic Disorder -Panic Disorder with agoraphobia |
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Social Phobia
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-Marked or persistent fear of social or performance situations in which embarrassment may occur
*has intense anxiety as a result or in anticipation *avoids the situations *interferes with normal routine or desired activities |
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Obsesive Compulsive Disorder
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-Axis I
-Persistent ideas, thoughts, or images experienced as intrusive -Can't get it out of mind -Most of the time recognized as products of own mind -Repetitive, purposeful, intentional behavior to reduce anxiety or distress -Clearly excessive behavior *> 1 hour/day or interferes with usual functioning -Medications: *clomipramine TCA *fluoxetine (Prozac) SSRI *fluvoxamine SSRI |
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Agoraphobia
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-Anxiety about being in places or situations where escape may be difficult or embarrassing or in which help might not be available
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Antianxiety/Anxiolytic Drugs
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-Benzodiazepines = sedatives
*alprazolam (Xanax) *chlordiazepoxide (Librium) *diazepam (Valium) *lorazepam (Ativan) *oxazepam (Serax) -Action: potentiate GABA in the limbic area of the brain, depresses the CNS -Effects: *decrease anxiety *decrease withdrawl sx from ETOH *control convulsions *produces skeletal muscle relaxation -Side Effects: *Dizziness *Drowsiness *Blurred Vision *Othostatic BP changes |
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Nursing Considerations for Benzodiazepines
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-Do not take with ETOH or other CNS depressants
-Peak levels in 1-4 hours (long half life) -Withdrawl sx: wean gradually over several weeks -Caffeine interferes with effectiveness *Potential for dependance and tolerance -Overdose Tx: *Call a code *Open airways/give O2 *Stimulate verbally to keep awake "breath deeply" *Start IV *give flumazenil (Mazicon) |
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Other Anxiolytic Drugs
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-Non-Benzodiazepines
-buspirone (Buspar): 2wks to work *good for generalized anxiety disorder -Antihistamines *diphenhydramine (Benadryl) -Anxiolytic *hydroxyzine (Vistaril IM, Atarax PO) |
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Paroxysmal Excitement
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-Disinhibition: adverse reaction
-Opposite of what should happen -Associated with Xanax and Ativan |
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CAGE Test
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-Done for suspected substance abuse
*C: cutting down on drinking *A: annoyed about being asked about drinking *G: guilt *E: eye opener, drinking first thing in the morning |
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disulfiram (Antabuse)
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-Causes severe nausea, vomiting, flushing, dizziness, and hypotension when taken with ETOH withing 48 hours
-Can lead to shock and death -Inhibits acetaldehyde dehydrogenase which normally metabolizes the actaldehyde |
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Alcohol Equiv.
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-1 1/4 oz 80 proof ETOH is the same as:
*12oz beer *4oz wine |